A new analysis of FDA data, published on September 10th by the Milwaukee Journal Sentinel/MedPage Today, reveals the dangers of the common prescription of stimulant drugs for attention deficit/hyperactivity disorder (ADHD). The authors, John Fauber, Matt Wynn, and Kristina Fiore, found 19,000 complications from ADHD medications that were reported to the FDA—and they believe the actual number may be much higher than the reports indicate.
The most common drugs prescribed for ADHD include amphetamines such as Adderall and Vyvanse and methylphenidates such as Ritalin. All of these medications carry the potential for addiction and abuse.
In the early 2000s, the overprescription of painkillers was associated with a staggering jump in the amount of people abusing the drugs, leading to what is now termed the “opioid epidemic.” Although addiction and death due to the use of prescription painkillers have been covered extensively in the media, the abuse of stimulants prescribed for ADHD has received little attention.
Indeed, the anecdotal reports of college students using stimulants to study for their exams have received scattered attention. For instance, a 2013 study revealed eightfold increases in amphetamine levels in wastewater during final exams. However, this recent exposé illustrates the staggering impact of abuse of ADHD drugs and addiction to prescription stimulants.
The number of emergency room visits due to ADHD medications increased by 400% over the past seven years, paralleling the four-fold increase in recreational use of ADHD medications by adults between 2006 and 2014. The long-term effects of ADHD medications are not known, as rigorous studies follow patients’ use over the course of several weeks—months, at most—rather than the years that individuals will be consistently taking these medications. However, adverse events noted in the analysis of FDA data include fatal heart attacks and kidney failure, and adults taking these drugs are at much higher risk of severe side effects, according to the FDA data.
Experts have raised concerns about overdiagnosis of ADHD due to the recent expansion of diagnostic criteria. In the 2013 edition of the Diagnostic and Statistical Manual, Fifth Edition (DSM-5), the amount of symptoms required for a diagnosis of ADHD decreased to five from the more stringent six symptoms. Additionally, while previous diagnostic criteria required ADHD symptoms to be present before the age of seven, new criteria broadened the age range to 12.
Concerns have been raised that the broadening criteria would lead to the overprescription of stimulants. In fact, a recent study in the journal PLOS Medicine revealed that 78% of individuals on the panel revising these guidelines had financial ties to the pharmaceutical industry.
Critics have argued that ADHD diagnostic criteria are highly subjective and can resemble non-pathological human foibles. For instance, overlooking details, having difficulty with lengthy reading, being distracted, and being forgetful are all considered symptoms of ADHD. Strengthening this position are studies revealing that the youngest children in kindergarten are far more likely to receive a diagnosis of ADHD than older classmates. According to the CDC, in 2011, 11% of children had been diagnosed with ADHD, and two-thirds of children diagnosed with ADHD were prescribed medication.
Additionally, the ambiguity of the symptom criteria means that ADHD is quite easy to fake. In fact, a 2010 study revealed that this is already problematic—as many as one in four diagnoses of adult ADHD may have involved faked symptoms. While this study occurred before the diagnostic criteria were relaxed, that number will likely only increase.
The expansion of vague diagnostic criteria means it may be easy to misdiagnose ADHD or for patients to fake symptoms to obtain a prescription for recreational use. The latest evidence, the report concludes, points to a similar pattern of overprescription and abuse between the opioid epidemic and ADHD drugs.